Fastball Failing? Do not Look to UCL Restore for Enchancment

— Velocity, different efficiency measures no higher after Tommy John process

by
John Gever, Contributing Author, MedPage At this time
March 7, 2023

LAS VEGAS — Baseball pitchers on the lookout for extra warmth shouldn’t anticipate assist from ulnar collateral ligament (UCL) reconstruction, higher referred to as Tommy John surgery, researchers reported right here.

Common fastball pitch pace was about the identical relative to pre-procedural statistics, and pitchers tended to throw fewer fastballs than earlier than, in response to Oliver Sax, DO, of Sinai Hospital of Baltimore, and colleagues.

As well as, pitchers’ management appeared to endure, the researchers reported from their examine of 174 main league pitchers, with 3.9 walks issued per 9 innings pitched after surgical procedure, in contrast with 3.5 beforehand (P<0.05).

Findings from the examine had been reported on the American Academy of Orthopaedic Surgeons’ annual meeting.

One of many few surgical procedures named after its first patient relatively than the doctor who developed it, Tommy John surgical procedure entails changing, or augmenting, the UCL with connective tissue taken from elsewhere within the affected person’s physique. Pitchers’ throwing motions put super pressure on the UCL, notably once they repeatedly throw as arduous as they will. A fastball specialist would possibly throw as many as 60 or 70 in a single recreation. Because of this, UCL tears are frequent. These had been basically career-ending till Frank Jobe, MD, pioneered the process in 1974, serving to Tommy John pitch successfully for an additional 14 years.

Sax and colleagues, nonetheless, identified that some folks within the sport have instructed that UCL reconstruction may even be carried out in wholesome gamers to enhance their efficiency — regardless of “inconsistent” outcomes from previous research of outcomes.

Because of baseball’s obsessive assortment of statistics, the group was capable of analyze a spread of outcomes in 174 main league pitchers who underwent UCL reconstruction from 1997 to 2020. Pitchers’ imply age was 26 on the time of surgical procedure.

Pre- and post-procedural efficiency measures, along with walks per 9 innings, had been as follows:

• Fastball proportion of pitches thrown: 61.2% pre vs 55.0% publish, P<0.001

• Imply fastball velocity in mph: 92.3 pre vs 91.5 publish, P=0.195

• Earned run common: 4.2 pre vs 4.4 publish, P=0.316

• Walks plus hits per inning: 1.4 pre and publish

• Strikeouts per 9 innings: 8.1 pre vs 8.3 publish, P=0.377

• Wins above replacement: 6.8 pre vs 3.9 publish, P=0.003

This final discovering is particularly telling, as it is a measure of how a person pitcher stacks up in opposition to league averages — it is supposed to point what number of extra wins the group achieved with this pitcher versus a hypothetical substitute. It combines quite a lot of completely different statistical measures equivalent to innings pitched per recreation, walks and runs given up, and others. The discount by practically half after UCL reconstruction means that pitchers typically didn’t return to their earlier type.

It is potential, although, that this displays gamers’ ageing, as post-surgical rehabilitation sometimes takes greater than a yr. Amongst 276 main league pitchers present process surgical procedure from 1974 to 2020 (together with the 174 with full efficiency outcomes), Sax and colleagues discovered a imply lapse of 19 months for his or her return to the foremost league degree. At the very least anecdotally, it is common to want extra time to “shake off the rust” after lengthy absences from competitors, such that it may very well be 3 years after surgical procedure for gamers to achieve most efficiency.

Total, the researchers concluded, their outcomes are “opposite” to these suggesting that pitchers may truly enhance their fastballs with UCL reconstruction.